Monday, February 11, 2013

One of the
most important functions of public health is to monitor the health of the
communities we serve and share what we learn—we call this activity community
health assessment.We argue that when
people have objective information about health, they will make better public
policy decisions.All other things being
equal, I do think that is true. Of course all other things are not usually
equal: in our politicized, market-driven world information is manipulated, and people
don’t easily let go of strongly held beliefs even when presented with objective
information that challenges those beliefs. So we also have to spend time working to establish
the conditions under which people can appreciate objective information.

I recently
prepared an orientation for three new members of the Mid-Michigan District
Health Department’s Board of Health.I thought
a fun way to introduce the concept of community health assessment would be to
challenge the Board members to guess which way health trends are moving:homicide deaths—up or down? Drug deaths—up or
down? And let them have a freewheeling discussion about what the trends mean. I
thought the exercise was a lot of fun and the trends we looked at were
surprising to me, so I thought I’d share some of them on the blog.

I wanted to get
easy-to-understand data which I could graph myself. So I went to the Michgan Department
of Community Health’s website, www.michigan.gov/mdch
and clicked on “statistics”.I found a
ton of good stuff.For those who are
interested I put some technical notes at the end of this post.

The first thing
I want to share is the homicide rate in Michigan shown in the chart below. I
was surprised at the clear long-term downward trend, surprised no doubt,
because the recent mass shootings are on my mind.

The chart gives
the rate of homicides per 100,000 people. In 2010, 6.4 out of every 100,000
residents were intentionally killed, which is just a little over half the rate
in 1988 when 11.8 residents were killed for every 100,000 (Click here for more information).

One chart by
itself can’t answer all our questions.For
example, you might suspect that homicides are down because the population is aging—a
smaller proportion of the population is at the age where people are likely to
commit homicide.The MDCH website has data
that address this question, showing that Michiganders of all ages are truly
less homicidal than we used to be.You
might also wonder if attempted killing is rampant, but our phenomenal emergency
rooms are simply saving more of the victims. That’s not it—while it’s true
emergency medicine has improved, assaults are down, too.

If we are mostly
interested in gun violence, we might want to know whether the proportion of
homicides accounted for by guns has changed over time. Indeed it has and the increase in homicides you
can see in the chart that goes from about 1983 to 1992 was caused by an increase in handgun violence.
But on average, over time, guns have steadily accounted for a little over
two-thirds of all homicides. People who worry about guns also care about
suicides and accidents. Guns are used in most suicides. In fact the rate of suicides has been fairly
flat over time.In 2010 there were 12.5
suicides per 100,000 residents, exceeding the rate of homicides.In addition, if you believe that some places
have higher homicide rates than others you’d be absolutely right. Low-income urban
neighborhoods often (but not always) have high homicide rates, but so do some
low-income rural areas. African-Americans are more than four times as likely as
Whites to be a victim of homicide. This graph obscures the tragic disparity in
homicide deaths between communities.

And finally,
even though homicides are down so much, it doesn’t mean guns are not a problem.
When you combine all the forms of mortality from guns: homicides, suicides and
accidents, deaths from guns are about double deaths from all forms of homicide
combined. Still, given what’s on the news right now, I was really surprised to learn
that, over all, we are a lot safer from homicide than we were in the recent
past.

Here is another trend that surprised me: drug-related
deaths. Again the data are displayed as the rate of drug related deaths per 100,000 residents. The chart below shows that between 1999 and 2010 drug-related deaths in
Michigan increased over 240 percent from 7.1 to 17.3 per
100,000.

What
accounts for the explosion in drug-related deaths? Chrystal meth? “Bath salts”?
In fact, deaths from legal, prescription drugs outnumber deaths from illicit
drugs.Deaths from
legal, prescription opioids and hypnotics increased by a factor of four during
the time period covered by the chart (Click here for more information).

The data in the chart include many related ways of dying from drug use: taking
drugs to get high and overdosing, mixing drugs or drugs and other substances, accidents
and injuries (such as car crashes) related to drug use, and it includes
prescription errors by the health care system. One of the most commonly abused substances—sometimes
called a drug—is alcohol, and this chart does not include alcohol related deaths
(unless another drug was involved). Alcohol related mortality in Michigan has
been fairly constant over time. In 2010, 8.1 persons per 100,000 died from a
cause related to alcohol use. Deaths from legal, prescription drugs have surged
past alcohol alone as a cause of death.

Many things are being done in the counties we serve to try to combat drug related deaths. Clinton, Gratiot and Montcalm counties all have programs to permit people to safely dispose of prescription drugs. The area hospitals are implementing policies to curtail drug-seeking in EDs. And many pharmacies will take back unused medications. Still, I was really surprised that drug-related deaths are 2.7 times
more common than homicide deaths.

Rattled by
the scary news about guns? Well, think twice before asking your doctor for a
prescription to calm yourself down!

=================

NOTES

The data in both
charts are the rate per 100,000 Michigan residents. Graphing it that way
protects against the mistake of thinking, for example, that homicides are
trending down when really all that is happening is people are leaving the State
resulting in fewer homicides.

The reason that
the most recent year in both charts is 2010 instead of a more recent year is
that it takes a long time to accurately finalize the details of death
certificates, especially those involving crimes, and then it takes more time to
analyze the data and put it on line, especially with staffing levels at MDCH
being so low.

The data have been age adjusted. Homicides are
more common among younger people so in an aging population the trend could
appear to be going down, even if younger people were actually experiencing more
homicides per capita. Age adjusting is a simple procedure that fixes this.

Friday, February 8, 2013

A few years ago Mid-Michigan first responders and public
health workers gathered in Lansing to wrestle with the problem of how to
encourage people to take preparedness more seriously.The idea they came up with was a marketing
campaign they dubbed “Do 1 Thing”.Do 1
thing encourages people to take a moment once each month to do one thing to be
more prepared for emergencies.It breaks
preparedness down into simple steps that any family or person can take:
designating a place to meet if you have to leave your home, making a plan for
how you would assist an elderly relative, storing some clean water, etc.Do 1 thing is promoted through public service
announcements, a website, printed calendars, etc. At their website www.do1thing.com you can sign in and over the
course of a year it will walk you through 12 simple steps to be more prepared.
And you can follow it on Twitter at @Do1ThingUS.

Now Do 1 Thing is starting to get national attention. CDC is
recommending its use to other communities around the country. Victoria Harp of
CDC’s Office of Public Health Preparedness and Response said, “Our Learning
Office has highlighted the work of the Do 1 Thing project as a great example of
a Whole Community approach to emergency management.This year our Communications Office is
committing to the program.”CDC and FEMA
will be promoting Do 1 Thing to communities throughout the year.

People from the Mid-Michigan District Health Department’s
service area who worked on the project included Lynda Farquharson our Emergency
Preparedness Coordinator, Jennifer Churchill who was our Public Information
Officer and Larry St. George and Steve Lehman from Clinton County Emergency
Services. Thanks to them and everyone who worked on the project and
congratulations for starting a national trend!